CREDIT CARD CHARGE FORM

Group’s Name______________________________________________________

Passenger(s)’ Name(s)________________________________________________

___________________________________________________________________

Cardholder’s Name__________________________________________________

Address____________________________________________________________

__________________________________________________________________

Tel. #_____________________________________________________________

Connection of passenger(s) with cardholder _____________________________

___________________________________________________________________

Card #____________________________ Expiration Date__________________

Please check one: _______VISA _______AMEX ________MASTER CARD

Cardholder’s Signature_______________________________________________

***All Bravo’s prices reflect a 5% cash discount. For those clients wishing to pay by credit card, they will incur a price differential representing the percentage rate of the cash discount (5%).

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FOR OFFICE USE ONLY: Date______________________

Accepted________ Authorization #_____________

Rejected________